The Coming Cost of Superbugs: 10 Million Deaths Per Year

If you weren't taking antibiotic resistance seriously before, now would be a good time to start.

A project commissioned by the British government has released estimates of the near-future global toll of antibiotic resistance that are jaw-dropping in their seriousness and scale: 10 millions deaths per year, more than cancer, and at least $100 trillion in sacrificed gross national product.

The project, called the Review on Antimicrobial Resistance, was commissioned by UK Prime Minister David Cameron last summer, a follow-on to the dire report issued in 2013 by the UK's Chief Medical Officer, which ranked resistance as serious a threat to society as terrorism. To chair the effort, Cameron recruited Jim O'Neill, previously the head of economic research for Goldman Sachs (and the person credited with coining the acronym BRICs – Brazil, Russia, India, China – as part of forecasting that global economic power would shift south and east). The Review is envisioned as a two-year project that will publish periodically, ending in July 2016 with recommendations for actions to blunt the threat that antibiotic resistance poses worldwide. (The project is supported by the nonprofit Wellcome Trust.)

Their first paper, released late last week, is based on work by two consulting teams, from RAND and KPMG, examining just the effect of resistance in six pathogens: three commonly resistant bacterial infections, *Klebsiella pneumoniae, E. coli * and MRSA; and three globally important diseases: HIV, TB and malaria. It doesn't examine the effect of resistance in other pathogens; and it doesn't attempt to estimate either healthcare costs or secondary social costs (more on that below). So it is a conservative effort, several different ways.

And yet, its baseline estimates of the size of the global problem are breathtaking.

Among them:

Antibiotic resistance currently accounts for an estimated 50,000 deaths in the US and Europe, which have surveillance to support those numbers. (The CDC puts the number for the US at 23,000.) But the project estimates that the actual current death toll is 700,000 worldwide.

If antibiotic resistance were allowed to grow unchecked – that is, if there were no successful efforts to curb it or no new drugs to combat it (the latter is very plausible) – the number of deaths per year would balloon to 10 million by 2050. For comparison, that is more than the 8.2 million per year who currently die of cancer and 1.5 million who die of diabetes, combined.

Those deaths would cost the world up to 3.5 percent of its total gross domestic product, or up to $100 trillion by 2050.

Moreover, the toll of deaths – and the cost of them – would fall unevenly across the world, with the global south and Asia suffering to a greater extent and losing greater amounts of income. In one example, they estimate that 25 percent of all deaths in Nigeria could be caused by resistance if trends continue unchecked.

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Notably, the project doesn't attempt to estimate what they call the secondary costs of resistance: that is, the cost of having to forego routine medical procedures such as cancer care, joint and organ transplants and surgeries, because without antibiotics, the danger of infection would be too great. (They estimate that C-sections alone contribute 2 percent to annual GDP.) It also doesn't try to estimate what the healthcare costs would be of caring for those additional resistance illnesses and deaths.

The tone of the report is deathly serious, with a tinge of frustration that I am sure will be familiar to anyone who pays attention to resistance as a public health issue. (It certainly resonates with me.) It says:

For doctors and for those who have experienced first-hand the anxiety of an infection that is drug-resistant, as a patient or when caring for a loved one, there is little need to prove the importance of tackling (antimicrobial resistance).

However for the majority of people, including in leading policy and business circles around the globe, the threat of drug resistance might seem a distant and abstract risk, if it is known at all...

This is a looming global crisis, yet one which the world can avert if we take action soon.